JOB SUMMARY: The Population Health Specialist serves in an expanded role to collaborate with and support primary care physicians and their support staff to achieve the quality incentives as part of global payment and managed care contracts with the goal of optimizing our patients' health and well being.

DEPARTMENT SPECIFIC JOB RESPONSIBILITIES:

* Ensures translation services are provided in Spanish for Spanish speaking patients and employees when needed.

ESSENTIAL RESPONSIBILITIES:

* Extract data from Athena (HDS) and practice electronic medical record to correlate positive and negative changes in quality scores month over month.

* Monitor practice activity in Athena, both electronically and in person.

* Provides support to the practice for population management at the pod and practice level by tracking and
monitoring individual process and outcome measures for eligible managed care and Medicare patients
who have chronic diseases such as diabetes, cardiovascular disease, and depression.
* Acts as a key resource to PCP practices for the management of registries of patients who have chronic
diseases to ensure that they receive the required testing and medical management to promote optimal
health and clinical outcomes.
* Reviews registries with PCPs and/or key office staff to determine the next phase in patient care. Facilitates
appointment scheduling, telephone outreach and direct patient to educational resources. Coordinates the distribution of patient reminder letters on behalf of PCPs.

* 1-3 years experience in a healthcare setting, such as a physician's office, hospital department, or provider
relations, and a familiarity with standard quality measures, e.g., HEDIS. Familiar and proficient with medical terminology. * Ability to communicate and ensure translation services in Spanish for Spanish speaking patients and employees when needed.

* Familiarity with different electronic medical records, including WebOMR and eClinical Works; experience with
computer systems required, including web based applications. Must be highly attentive to detail, accuracy, and achieving end results. * Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases.

PREFERRED QUALIFICATIONS:

* Mature, energetic, and confident individual who will be able to participate in role development and who will be able to
adapt to role changes as they evolve.
* The ability to develop relationships and establish rapport when working with physicians and staff in the
community setting.

COMPETENCIES:

* Decision Making: Ability to make decisions that are guided by general instructions and practices requiring some interpretation. May make recommendations for solving problems of moderate complexity and importance.

* Problem Solving: Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents.

* Independence of Action: Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeks assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by supervisor/manager.

* WRITTEN COMMUNICATIONS: Ability to communicate clearly and effectively in written English with internal and external customers.

* ORAL COMMUNICATIONS: Ability to comprehend and converse in English to communicate effectively with medical center staff, patients, families and external customers.

* KNOWLEDGE: Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations.

* TEAM WORK: Ability to work collaboratively in small teams to improve the operations of immediate work group by offering ideas, identifying issues, and respecting team members.

* CUSTOMER SERVICE: Ability to provide a high level of customer service to patients, visitors, staff and external customers in a professional, service-oriented, respectful manner using skills in active listening and problem solving. Ability to remain calm in stressful situations.

PHYSICAL NATURE OF THE JOB:
Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally